Another belated disclosure from the pharmaceutical industry
Cholesterol-lowering drug (Statins) linked to increased risk of heart attack
By Naomi Spencer
19 January 2008

Under pressure from media reports, consumer groups and federal investigators, pharmaceutical giant Merck and its partner Schering-Plough released the findings of a long-withheld company-sponsored study of the cholesterol-lowing drug Zetia this week. The study, completed in April 2006, reveals that companies had been falsely marketing the drug as an effective part of heart disease prevention. Moreover, the data indicate a link between the drug—taken by about a million Americans—and increased risk of heart attacks and strokes.

The revelation is the latest in a series of scandals in the pharmaceutical industry and yet another demonstration of the federal Food and Drug Administration’s failure to protect the American people by ensuring the safety and efficacy of aggressively marketed medicines.

The so-called Enhance study was intended to demonstrate that Merck and Schering-Plough’s Vytorin, a combination of Zetia and another cholesterol-lowering drug, Zocor, reduced the build-up of fatty plaque in the arteries in addition to lowering so-called bad cholesterol levels. Instead, data suggested the opposite: plaque built up in the arteries of patients on Vytorin at double the rate of those taking Zocor alone.

Zocor, along with Crestor, Lipitor, and other common cholesterol-lowering medicines, are known as statins. Statins work in the liver by blocking the formation of low-density lipoprotein cholesterol (LDL), or ‘bad’ cholesterol. Some research also suggests that statins can also reduce inflammation that may cause plaque to block or rupture heart arteries.

Zetia, by contrast, blocks LDL cholesterol absorption in the intestines. Previous studies have suggested that Zetia lowers LDL cholesterol levels in patients by 15 to 20 percent, and the recently released study found Vytorin lowered LDL levels in patients by 58 percent. However, as Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, commented to Time magazine January 15, “The bottom line is that we just don’t know what Vytorin does, because we don’t have the clinical trials. We know Vytorin blocks absorption of cholesterol. But what else does it block—something else in the diet that could be beneficial? We just don’t understand fully how it works.”

A question naturally arises: How did a drug, the pharmacological qualities of which were not published and not understood, pass muster with federal regulators?

The FDA approved Zetia in 2002 and Vytorin in 2004, and through heavy marketing the drugs became extremely popular. According to health care industry tracker IMS Health, doctors wrote 18 million prescriptions for Vytorin and 14 million for Zetia in 2006 alone.

Cholesterol-lowering drugs represent a $40 billion global market; Zetia and Vytorin account for nearly $5 billion in annual sales. Worldwide, nearly a million prescriptions are written each week for the drugs.

Beyond the Enhance study results, there are a number of other, less-publicized problems surrounding the drugs and their marketing.

When the FDA approved Zetia for sale, it accepted company drug trials that covered a relatively small number of patients, and lasted no longer than 12 weeks—a short term for drug testing. Yet, according to a December 21 report from the New York Times based on FDA documents, even the data from those limited trials suggested that Zetia posed dangers when taken along with statins.

The Times said 11 times as many people who took a Zetia and statin combination subsequently suffered serious health problems compared to those who took only a statin. Nearly all of those complications were liver-related. Yet the FDA regarded the risks, according to the paper, as “relatively minor,” approving the drug without requesting Merck-Schering-Plough to conduct longer trials.

Two years later, the FDA approved Vytorin against the recommendations of its own pharmacology reviewer, who warned that tests in laboratory animals had registered serious toxicity even in small amounts.

The Times also found references in FDA briefing papers to eight long-term studies of Zetia in combination with statins, conducted by Merck and Schering-Plough between 2000 and 2003. The FDA documents show that several other long-term trials were conducted involving thousands of patients, but the companies did not release the results.

The companies published only three of their studies, mostly covering short periods in which it was not possible to detect the development of liver problems. According to the Times, Schering-Plough vice president Robert Spiegel confirmed the existence of the studies but said they were not “scientifically important enough” to be published. “We’re pretty comfortable that people don’t have trouble tolerating Zetia,” he told the paper.

The drugs are sold in the US with only minimal warnings of potential liver damage. In Australia and Canada, however, regulators have issued warnings since 2005 about Zetia’s potential to cause hepatitis and pancreatitis.

A Schering-Plough spokesperson confirmed to the Times that some patients had been dropped from the Enhance study after testing revealed that they had “elevated liver enzymes,” suggesting that the newly released data may also yield evidence of Zetia’s risks to the liver.

The conduct of the companies and the FDA play like a repeat performance of the Vioxx scandal. Vioxx, Merck’s pain medication, was propelled by an ad campaign touting its potency as an arthritis pain reliever without the adverse side effects on the digestive system that can be caused by common medicines such as ibuprofen. The drug was used by more than 2 million people worldwide.

In 2000, just a year after its introduction on the US market, results of a large clinical trial suggested that Vioxx posed much greater risks, including the risk of increased heart attacks, than older painkillers on the market. Merck disputed the findings, only withdrawing the drug in 2004, after another clinical trial definitively linked Vioxx to increased heart attacks and strokes. Internal company documents subsequently revealed that Merck researchers had warned of the risks several years before. Likewise, whistleblowers within the FDA warned that tens of thousands of Vioxx patients had suffered heart attacks, but the agency lacked the authority and the will to issue regulations on the drug.

Nor is Vioxx the only similar case. In 2006, the antibiotic Ketek (telithromycin), marketed by French pharmaceutical Sanofi-Aventis, and prescribed more than 5 million times in two years, was found to have submitted fraudulent data to the FDA masking potentially fatal liver risks. The agency was flooded by voluntary patient reports of adverse reactions, leading David Graham, head of the FDA’s drug safety office, to say that federal approval of the drug had been a mistake and recommend the drug’s “immediate withdrawal.”

“It’s as if every principle governing the review and approval of new drugs was abandoned or suspended where telithromycin is concerned,” Graham wrote in a June 16, 2006, e-mail obtained by the New York Times. “We don’t really know if the drug works; no one is claiming it works better than other, safer drugs; and we’re flying blind as far as safety goes, except for our own A.D.R. [adverse drug reaction] data that suggests telithromycin is uniquely more toxic than most other drugs.”

In May 2007, the New England Journal of Medicine published an analysis of more than 40 clinical studies of the diabetes drug Avandia, produced by pharmaceutical giant GlaxoSmithKline. The journal’s findings suggested Avandia raised the risk of heart attack by 43 percent, and the risk of cardiovascular death by a staggering 64 percent. FDA officials responded by saying that the agency was postponing a decision on the drug’s safety for two years, despite its own estimate that as many as 60,000 to 100,000 heart attacks may have been linked to Avandia during its eight years on the market.

All of these instances are the result of the subordination of public health to corporate profits. Medicine under capitalism is inherently compromised by this conflict of interest, putting millions of ordinary people at risk for companies’ bottom lines.

In September, the FDA Revitalization Act was signed into law, ostensibly strengthening the agency’s oversight powers. The legislation enables the FDA to require post-marketing drug safety tests and changes to labeling. The FDA now also has the authority to “request” changes to television ads for drugs aimed at consumers.

The law also requires sponsors of all clinical drug trials to register the studies in a public database managed by the National Library of Medicine. Yet, as the numerous as-yet undisclosed Zetia trials exemplify, the law is meaningless if it is not enforced.

Significantly, the new law reauthorized the 1992 system of fees whereby the FDA’s drug review process is largely funded by corporations submitting their products for approval. The FDA’s safety division is heavily dependent upon corporate money for lack of federal funding.

According to the consumer advocacy group Public Citizen, the pharmaceutical industry gave $400 million to the drug division of the FDA. “You would have to be living on a cloud to think that the money doesn’t have an impact on the FDA’s drug approvals or regulation of the industry,” Sidney Wolfe, the group’s Health Research director, commented in a statement January 14.

In addition, the new law does not substantively address the relations between the pharmaceutical industry and doctors. Drug companies establish a market in large part by establishing relationships with physicians through gifts and perks.

These gifts are regulated only by voluntary industry guidelines and justified on the basis that corporate sales representatives provide vital information to medical practitioners. The Pew Charitable Trust’s Prescription Project found drug companies spend $7 billion on gifts to doctors and at least $18 billion on free samples for doctors’ offices each year.

According to a report in the January issue of the AARP Bulletin, a publication of the American Association of Retired Persons, “Each day more than 101,000 drug company reps—one for every five office-based physicians—call on the nation’s doctors.” Citing a 2005 report by medical products industry consulting firm Health Strategies Group, the AARP Bulletin reported that “Primary care physicians, on average, have 28 interactions a week with drug reps.” These representatives are paid to promote new drugs and downplay any side effects or risks.

The Bulletin noted that the drug industry is “vehemently opposed to marketing-disclosure legislation.” Industry group Pharmaceutical Research and Manufacturers of America (PhRMA) calls such regulations “no extra value to patients” and “a costly, unnecessary burden” for drug companies. PhRMA senior vice president Ken Johnson told the Bulletin that “In the end, pharmaceutical marketing is one of several important ways for physicians to receive information they need to make sure patients are safely and effectively treated.”

This by emaiil from top notch clinical acquaintance of mine
Thanks Andy....

Andy Pears - I have been explaining how and why statins destroy heart tissue for over 15 years now. if you block the production of coQ10 the tissue will deteriorate until its dead. if people read the patents its all in there. just Google the HMG-CoA reductase pathway. its totally blocked and that is what makes coQ10 from cholesterol. its why it goes up as you get older because the body needs more substrate to make hormones etc. likewise all enzymatic processes become less with age

Because drug reps sell the lie as i was once expected too. doctors are taught very little biochemistry if any, and still think the cholesterol is a killer, when in fact it has been proven that homocysteine is the cause of clogged arteries not fats. think of homocysteine as a brillo pad which damages the endothelial lining of the arteries. the think of those linings as a non stick surface of a frying pan. then think what happens once that non stick surface is rough or damaged when you fry an egg (the cholesterol or fats). homocysteine can be re-metabolised with Folate, B6, B12.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3026708/

I'm more interested in preventative medicine which of course is the exact opposite of mainstream medicine thanks to big pharma. however, im currently working on a simple product that will seriously boost everyone's immune system and prevent many illnesses without being controlled by the MCA. just hope my VC gets it.

Abstract
The role of blood cholesterol levels in coronary heart disease (CHD) and the true effect of cholesterol-lowering statin drugs are debatable. In particular, whether statins actually decrease cardiac mortality and increase life expectancy is controversial. Concurrently, the Mediterranean diet model has been shown to prolong life and reduce the risk of diabetes, cancer, and CHD. We herein review current data related to both statins and the Mediterranean diet. We conclude that the expectation that CHD could be prevented or eliminated by simply reducing cholesterol appears unfounded. On the contrary, we should acknowledge the inconsistencies of the cholesterol theory and recognize the proven benefits of a healthy lifestyle incorporating a Mediterranean diet to prevent CHD.

Keywords: Cholesterol, Statins, Coronary heart disease, Mediterranean diet, Cardiovascular disease, Mortality
Core tip: Traditional efforts to prevent cardiovascular disease have emphasized the benefits of cholesterol lowering and statin drugs. Often overlooked is the fact that numerous studies of cholesterol lowering have failed to demonstrate a mortality benefit and the benefits of statins may have been overstated. The Mediterranean diet has consistently lowered cardiovascular events and mortality in numerous studies and does not typically lower cholesterol levels. Alternative theories of atherosclerosis are independent of cholesterol metabolism and may provide the key to future preventive strategies.

INTRODUCTION
Nearly twenty years ago two landmark randomized clinical trials appeared in The Lancet which forever changed the course of medicine for patients with coronary heart disease (CHD). The 4S study employed a cholesterol-lowering statin drug and reported a 30% mortality reduction[1]. The Lyon Diet Heart Study utilized the Mediterranean diet and reported a 70% mortality reduction[2]. Subsequent studies of the Mediterranean diet have confirmed these findings and also shown a reduced risk of cancer, diabetes, and Alzheimer’s disease[3-6]. Subsequent statin studies have led the United States Food and Drug Administration to issue warnings regarding the increased risk of diabetes and decreased cognition with statin drugs. Paradoxically, statins have gone on to become a multi-billion dollar industry and the foundation of many cardiovascular disease prevention guidelines while the Mediterranean diet has often been ignored. We believe this statin-centric cholesterol-lowering approach to preventing CHD may be misguided.

ASSOCIATION DOES NOT EQUAL CAUSATION
The cholesterol hypothesis links cholesterol intake and blood levels to cardiovascular disease. Because cholesterol is considered a risk factor for atherosclerosis many believe that lowering cholesterol in the blood is the best way to prevent CHD. Ideally, risk factors should help us distinguish those who will develop a disease from those who will not. However, if one examines the original Framingham Heart Study data (as an example) it is clear that the cholesterol levels of those who developed CHD and those who did not overlap except when the total cholesterol level exceeded 380 mg/dL or was less than 150 mg/dL (Figure ​(Figure1).1). Moreover, cholesterol may be associated with CHD but that does not prove causation. Despite the fact that high triglycerides and low HDL have long been associated with CHD, studies designed to raise HDL or lower triglycerides have failed to reduce CHD mortality. Similarly, cholesterol should not automatically become a treatment target. It may be a leap of faith to assume that lowering cholesterol is the best way to prevent CHD.

Figure 1
Figure 1
Serum cholesterol distribution among coronary heart disease and non-coronary heart disease patients in the Framingham Heart Study[43]. Reprinted with permission of the publisher. CHD: Coronary heart disease.
LOWERING CHOLESTEROL MAY NOT LOWER CARDIOVASCULAR MORTALITY
The rare occurrence of CHD in isolated, rural societies such as Tukisenta, New Guinea has been attributed to low cholesterol levels[7]. However, it is equally plausible that the diets and lifestyles of these individuals may protect them from CHD. While we may never be certain if low cholesterol or a healthy lifestyle (or both) are responsible for preventing CHD in these societies, there is ample evidence that lowering cholesterol does not consistently lower CHD mortality. Reducing cholesterol blood levels by reducing dietary saturated fats is commonly recommended, but an exhaustive review and meta-analysis of 72 dietary studies concluded that reduced consumption of saturated fat does not reduce cardiovascular mortality[8]. Many drugs such as niacin, fibrates, and bile acid sequestrants can lower cholesterol levels, but the recent AHA/ACC guidelines on cholesterol concluded that these drugs do not lower CHD mortality rates[9]. Moreover, the results of cholesterol-lowering statin trials, as will be discussed and analyzed later, do not consistently lower mortality rates[10]. Consider also the dramatic mortality benefit of the Mediterranean diet in the Lyon Diet Heart Study which was achieved without a reduction in cholesterol levels[2-4]. Thus, the hypothesis that lowering cholesterol lowers mortality from CHD is not supported by many clinical research studies.

EARLY STATIN TRIALS MAY HAVE BEEN FLAWED
Early statin trials reported significant mortality benefits, yet serious concerns have been raised in some studies regarding biased results, premature trial terminations, under reporting of adverse events, high numbers of patients lost to follow-up and oversight by the pharmaceutical company sponsor[10]. Heightened awareness within the scientific community regarding problems in clinical trial conduct and analysis - exemplified by the unreported risk of heart attacks in patients taking the pain killers Vioxx and Celebrex - led to new regulatory rules for clinical trials in 2005[11]. Curiously, statin trials conducted after 2005 have failed to demonstrate a consistent mortality benefit[10].

The frail & elderly should not be guinea pigs or cash cows for powerful pharmaceutical giants: Pills can be vital but in doling out too many the NHS can harm rather than help… so is it time to STOP the elderly from taking tablets, asks DR JAMES LE FANU https://dailym.ai/2IeIJlJ

Pills can be vital but in doling out too many the NHS can harm rather than help… so is it time to STOP the elderly from taking tablets, asks DR JAMES LE FANU
By James Le Fanu For The Daily Mail
00:10, 14 May 2018, updated 09:15, 14 May 2018
http://www.dailymail.co.uk/health/article-5724851/Pills-vital-dolling- NHS-harm-help.html
In Saturday’s Mail, Dr James Le Fanu said doctors are doling out too many pills
He said that this could be harming us and even shortening our lives
Today, he explains why the elderly in particular can be adversely affected
In an extract from his disturbing new book in Saturday’s Mail, Dr James Le Fanu argued that doctors are doling out too many pills. He said that ever-greater levels of medication could be harming us and even shortening our lives.

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Today, he explains why the elderly in particular can be adversely affected.

Most of us probably think that in terms of our health, there’s never been a better time to be getting older. After all, so many of the tribulations of later life — from angina to cataracts, and arthritis to heart failure — can now be vanquished with a simple medical procedure or a prescription of pills.

So, particularly if you are over 70, there is much to be grateful to modern medicine for. But I’m afraid there is also much to be worried about. Because the shocking truth is that the NHS is guilty of a terrible betrayal of our elderly — people who have trusted their doctors, without question, their entire lives.

As a GP myself, I’m fully aware that caution when it comes to prescribing medication is critical. As the classic medical textbook on pharmacology, that I was required to learn as a student, puts it: ‘Any drug that is worth using can cause harm. Drug therapy in the elderly should be kept to a minimum.’

Over the past few decades, however, this cardinal rule of prescribing has been wilfully ignored in the UK — with deeply worrying consequences.

In an extract from his disturbing new book in Saturday’s Mail, Dr James Le Fanu argued that doctors are doling out too many pills +7
In an extract from his disturbing new book in Saturday’s Mail, Dr James Le Fanu argued that doctors are doling out too many pills
You have only to consider the following appalling statistics to understand what I mean:

In just nine years, annual hospital admissions due to adverse drug reactions have increased by an astonishing 76.8 per cent.
Twice as many older people are suffering from kidney and heart damage than in recent years, due to the drugs they’re taking.
Adverse drug reactions have been reported in 44 per cent of hospital inpatients and 35 per cent of outpatients. They account for 10 per cent of emergency hospital admissions.
Studies that examined what people had been prescribed found that two-thirds were on inappropriate medication.
The risk of side-effects increases from 13 per cent for those taking two drugs to 58 per cent for those taking five, and to 82 per cent for those taking seven or more.
The proportion of adults prescribed more than five drugs doubled in 15 years to 20 per cent. The proportion given more than ten tripled to 6 per cent. Most of these patients were elderly.
Many of these are victims of what doctors call ‘the prescribing cascade’: a patient experiences bad side-effects from one drug, so his doctor prescribes another to deal with them. Yet another is prescribed to deal with the side-effects of the second drug, and so on.

The following letter, sent to me in my capacity as a GP with an advice column, speaks for itself. It is from a woman whose 71-year-old husband is taking eight pills in the morning and five in the evening.

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‘My husband has lost all confidence. He gets up in the morning with no energy and this continues all day long; he is not able to work in the house or the garden. He occasionally washes the dishes but this is too much for him.

‘On inquiring about the necessity for taking so many medications, the GP said that he would not be here if he stopped any of them.’

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Her letter takes us to the heart of the problem of over-prescribing in the elderly.

But here’s the most interesting thing: the corollary to that is that the most beneficial ‘treatment’ you can really give to those who are 70 or over is to reduce the number of drugs they are taking.

This will not only alleviate the symptoms they suffer from over-medication, but also reduce their risk of requiring admission to hospital, and prolong their lives.

This was demonstrated unequivocally around a decade ago when a doctor decided to conduct a daring experiment.

Dr Doron Garfinkel simply stopped prescribing 320 drugs that were being taken by around 100 frail residents of an Israeli nursing home. He also roped in a control group of 100 equally frail residents who were still taking their pills. The results were extraordinary.

Over the following year, deaths were halved in the group that had stopped taking the medication, falling from 45 per cent to 21 per cent. There was also a steep drop in those needing emergency hospital admission, from three in ten down to just one in ten.

This is a better result than that achieved by any drug. Ever.

You’d think, therefore, that British doctors would be keen to follow Dr Garfinkel’s example. After all, in a 2014 poll, nine out of ten GPs conceded they were over-treating their older patients.

Yet the over-medicalisation of oldies remains as prevalent as ever in the UK.

The following case shows just how easily it can happen — and what the consequences can be. In his late 70s, Mr Clark was fit and active, playing tennis a couple of times a week. Then, like so many of his age group, he was routinely prescribed a cholesterol-lowering statin by his well-meaning GP.

Two months later, Mr Clark returned to the surgery, complaining of muscular aches and pains. In the absence of any obvious explanation, he was prescribed the anti-inflammatory drug ibuprofen.

A couple of months after that, he was summoned to the surgery for a flu jab. The practice nurse took his blood pressure and found it raised, so he was given a blood pressure-lowering diuretic.

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Another three months passed. One night, Mr Clark woke with a swollen and excruciatingly painful big toe, correctly diagnosed as gout. This required yet another drug, allopurinol.

When he returned to the surgery a few weeks later, the GP checked his blood sugar level, which had previously been normal.

In just nine years, annual hospital admissions due to adverse drug reactions have increased by an astonishing 76.8 per cent +7
In just nine years, annual hospital admissions due to adverse drug reactions have increased by an astonishing 76.8 per cent
This time it was raised, so Mr Clark was put on the anti-diabetic drug metformin. Soon afterwards, he began having severe diarrhoea, for which his doctor prescribed a drug called loperamide.

At the next consultation, Mr Clark asked his GP why ‘so many things seem to have gone wrong recently’. The doctor told him: ‘At your age, these things happen.’

But in fact, Mr Clark had become the unwitting victim of a classic prescribing cascade.

It was the statins that had caused the muscular aches and pains. The anti-inflammatories that he was prescribed for those raised his blood pressure.

To treat the raised blood pressure, he was given diuretics. These, in turn, increased the levels of both his blood sugar and uric acid, causing the attack of gout and the diabetes.

His raised blood sugar was dealt with by the drug metformin, and one of its side-effects is diarrhoea. And his gippy tummy was subsequently treated with loperamide.

Thus, Mr Clark’s initial prescription for a statin had led to a cascade of five further drugs — as well as a great many extra health problems.

Obviously, the more drugs you take, the higher the risk of an adverse reaction from any one of them. And when you’re elderly, that can be very dangerous.

Just taking more than five different medications can either exacerbate or cause dementia, recurrent falls, urinary incontinence and a lack of appetite.

Sometimes just a single drug can plunge you into a living nightmare. This was certainly the case for a retired academic who was diagnosed with rapidly progressive Alzheimer’s disease.

He could no longer read a page of text, recall what he’d just said, or recognise people he’d known for decades.

In his case, it was his family’s decision to take him off statins that made all the difference. At his next evaluation, he was told he no longer had Alzheimer’s.

It took another two years for him to recover fully, by which time he was reading three national newspapers a day.

Of course, many people take prescription drugs without developing Alzheimer’s or any other serious diseases. But oldies are more at risk. In fact, they’re three times more likely to have adverse effects caused by their medication than the relatively young. Which means that drugs are more dangerous the older you get.

There are several reasons for this. One is that the functioning of the liver and kidneys declines as you get older. The concentration of a drug in the blood and tissues can therefore reach potentially dangerous levels.

Secondly, elderly bodies are less able to call on glucose for energy when they need it. So an old person on blood pressure medication, for example, may feel dizzy when he stands up, which can lead to a fall.

Thirdly, and very importantly, blood pressure and levels of blood sugar and cholesterol rise naturally with age. A person in his 30s, for instance, may have a 5.5 level of cholesterol. But when he reaches his 60s, it will have risen to 6.5.

This is entirely normal. It’s the same for blood pressure and glucose. A systolic pressure of 160 is high for a 40-year-old, but ‘normal’ for a 70-year-old, and so on.

Over the past 30 years, however, experts have consistently lowered the threshold at which any patient will be diagnosed with elevated blood pressure, diabetes and raised cholesterol.

The result is that the vast majority of oldies — whose levels have gone up with age — now automatically qualify for treatment.

And treated they are, even though a great many of them don’t need the drugs at all. Take, for example, a man in his early 40s, whose cholesterol level of 7 is markedly higher than ‘normal’ for his age group, thus increasing the risk of a heart attack. That can be reduced, if only modestly, by taking statins.

But for someone in his 70s that same cholesterol level is only marginally higher than average for his peer group. So there’s less benefit in taking statins.

Due to his age, his chance of suffering from side-effects is much greater than for a man in his 40s. In other words, he’s almost certainly better off taking nothing.

Why, then, do doctors continue to over-medicate the old?

As I explained on Saturday, it’s partly because it’s the easiest way for GPs to maximise their income. Under the current NHS scheme, every person treated for blood pressure, cholesterol and diabetes earns them extra cash.

But they’re also often reluctant to take elderly patients off any of their multitude of pills.

Let’s look at it from the perspective of a GP faced with a 70-year-old female patient, Mrs Jones, who has slightly raised cholesterol and blood pressure.

She needs statins and/or blood pressure medication, he reasons, because the older you are, the greater your chances of developing heart disease or having a stroke. Indeed, three-quarters of strokes and heart attacks occur in those aged 70 and over. Trouble is, that’s by no means the whole story.

For most people in this age group, the misfortune of having a heart attack or stroke is only marginally related to their blood pressure or cholesterol level, if at all.

The GP may have read the studies about this, but that doesn’t stop him. He lifts his pen and starts writing out a prescription.

Twice as many older people are suffering from kidney and heart damage than in recent years, due to the drugs they’re taking +7
Twice as many older people are suffering from kidney and heart damage than in recent years, due to the drugs they’re taking
Why? Because by giving Mrs Jones statins or blood pressure drugs, he ensures that he’s off the hook.

If she has a stroke, he won’t have to justify to her relatives why he failed to prescribe any drugs. On the contrary, he’s done his best —and ticked the boxes on which his remuneration depends. This is literally ‘medicine by numbers’.

Later, if Mrs Jones complains of side-effects, her GP may still be reluctant to take her off the pills.

He may not recognise whether a symptom — say, fatigue or dizziness — is due to a drug reaction or another illness.

It gets even more confusing if Mrs Jones has been on the medication for a long time. In some cases, a drug that’s been well-tolerated for many years can later trigger harmful side-effects.

What, then, can you do if you suspect that you, or an elderly relative, are taking too many drugs or suffering from side-effects?

My advice would be first to arm yourself with research, and then have a discussion with your GP.

Most doctors, one hopes, would welcome the opportunity to improve the quality of their patients’ lives. But you need to ask.

Your doctor may tell you that taking statins or other drugs will help you avoid heart disease and other life-threatening conditions. It therefore takes some courage to say you don’t want them.

Before deciding, the best thing you can do is to weigh up the benefits and risks of various treatments for oldies. And always bear in mind that drugs should be kept to a minimum:

RAISED CHOLESTEROL

It’s almost impossible for those in their 70s and beyond to escape being prescribed a cholesterol-lowering statin.

But, as a recent review observes: ‘Despite their widespread use, evidence for the effectiveness of statins in the elderly remains unclear.’

So far the only clinical trial in Britain that has specifically examined the drug’s effects in the elderly found that men were just 1 per cent less likely to have a fatal heart attack. There was no advantage for older women at all.

The situation for those known to have heart disease is slightly better, as statins reduce the risk of a fatal episode by 1.9 per cent.

Harms: Statins can significantly compromise an older person’s quality of life. Side-effects range from crippling muscular aches and pains to a dementia-type syndrome.

Verdict: There’s no justification for the current near-universal prescribing of statins for oldies.

Their very modest benefits must be offset against the likelihood of suffering adverse effects.

Dr. Jonathan Morrell on the dangers of high cholesterol
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HIGH BLOOD PRESSURE

Treating raised blood pressure can be critical if it’s very high. But otherwise, there are various factors to consider.

The threshold for drug treatment at the moment is 150/80.

Let’s say your systolic pressure is 170. Drug treatment that brings it down to just over 140 has been found to reduce the likelihood of a stroke — but only by 2.2 per cent, and even less for a heart attack. So if your systolic pressure is 170 or less, you do at least have a choice.

Harms: Adverse effects caused by blood-pressure medication are common. Thiazide diuretics deplete the body’s salts (sodium and potassium) while beta blockers slow the heart. Both drugs can lead to serious disturbances of heart rhythm.

And there’s a further problem with the mass-prescribing of such medication for oldies: too much of a good thing can be bad for you.

While it might be desirable to reduce your systolic pressure to 150, if it goes much lower you start to run into trouble. The blood pressure may be insufficient to propel blood from the heart through narrowed arteries to the brain.

Indeed, people whose systolic pressure is running at about 120 may experience fatigue, weakness, unsteadiness and confusion, all of which may improve dramatically upon reducing the dose or stopping the medication.

Another sign of over-treatment is the sudden precipitous fall in blood pressure on standing up, which is more common in the elderly. Falls are clearly bad news for oldies, and low blood pressure makes them more likely.

Verdict: The rise of the systolic pressure with age is not necessarily benign. Still, caution is necessary when seeking to reduce it to that threshold of 150 +7
Verdict: The rise of the systolic pressure with age is not necessarily benign. Still, caution is necessary when seeking to reduce it to that threshold of 150
Verdict: The rise of the systolic pressure with age is not necessarily benign. Still, caution is necessary when seeking to reduce it to that threshold of 150.

What you don’t want is to experience a precipitous drop. To that end, blood pressure should be measured not only when sitting but also when standing, and preferably after mild exertion.

DIABETES

The rising prevalence of diabetes with age is closely related to the tendency to put on weight as the years tick by, due to eating and drinking more and exercising less.

As Daily Mail readers will know, the disease is reversible for many through losing weight and cutting back on carbohydrates in favour of meat and dairy products.

Most people learn they have the condition after a blood test gives them a score of 7.5 or higher. The main goal of drug treatment is to try to prevent serious complications, including heart disease, stroke, and impaired functioning of the kidneys, eyes and nerves.

Harms: Oldies on these drugs are particularly vulnerable to hypoglycaemia (or excessively low blood sugar), which can result in anything from confusion to going into a coma. Even a spell of confusion can be fatal, as it may lead to falls and serious injuries sustained in road traffic accidents.

Verdict: There’s been an alarming increase in hospital admissions of the elderly for drug-induced hypoglycaemic confusion or coma, ever since GPs were given financial incentives to test for diabetes in 2004. This strongly suggests over-treatment.

Anyone diagnosed with diabetes should try to achieve remission by changing their diet. The elderly would also benefit if targets for treatment were revised upwards from 7.5 to 8 or 9.

Adapted from Too Many Pills: How Too Much Medicine Is Endangering Our Health And What We Can Do About It by James Le Fanu, published by Little, Brown on May 24 at £13.99. To order a copy for £10.49 (valid to May 19) visit mailshop.co.uk/books or call 0844 571 0640. P&P is free on orders over £15._________________--
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Martin Van Creveld: Let me quote General Moshe Dayan: "Israel must be like a mad dog, too dangerous to bother."
Martin Van Creveld: I'll quote Henry Kissinger: "In campaigns like this the antiterror forces lose, because they don't win, and the rebels win by not losing."

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